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Pediatrics > Pediatrics Exam #2 > Flashcards

Pediatrics Exam #2 Flashcards

1
Q

Active immunization

A

Give an active toxin/part of the virus given

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2
Q

Separation time for live vaccines

A

4 weeks

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3
Q

3 inactivated or killed vaccines

A

Polio, Hep A, Flu

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4
Q

5 Living Vaccines

A

MMR, Varicela, Flumist, Rotavirus, Polio

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5
Q

2 recombinant vaccines

A

Hep B and HPV

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6
Q

Reassortment vaccines - 1

A

Rotavirus

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7
Q

Immunogenic vaccines

A

Pertussis
H flu
Meningiococcal
Pneumococcal

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8
Q

Toxoid vaccines

A

Diptheria and tetanus

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9
Q

Administration of vaccines

A

IM or SQ
Thigh in infants 3-4
Deltoid in 5-18

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10
Q

SQ vaccines

A

Measles and Yellow fever

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11
Q

Birth vaccinations

A

Hep B

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12
Q

2 months vaccines

A

Pediarix, HIB, Prevnar, Rota

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13
Q

Pediarix vaccine

A

Dtap, HBV, IPV

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14
Q

4 months vaccines

A

Pediarix, HIB Prevnar, Rota

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15
Q

6 months vaccines

A

Pediarix, prevnar, HIB

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16
Q

12 month vaccines

A

MMR, Varicella, Hep A

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17
Q

15 months vaccines

A

Dtap and Prevnar

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18
Q

18 months vaccines

A

HIB and Hep A

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19
Q

4 year vaccines

A

Dtap and IPV and MMR and Varivax

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20
Q

9 year old vaccine

A

HPV series

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21
Q

11 year vaccines

A

Tdap and Meningitis

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22
Q

16 year vaccines

A

Meningitis 2

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23
Q

17 year vaccines

A

Men B with booster a month later

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24
Q

General Contraindications to vaccinations

A

Serious allergic reaction
Immunecompromised
Moderate or severe illness

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25
Q

Contraindications to live vaccines

A

Severe immune suppression resulting from:
Congenital
HIV
Leukemia/Lymphoma
Cancer therapy
2mg/kg/day 2+ weeks steroids

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26
Q

2 MC strains covered by HPV vaccine

A

16 and18

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27
Q

Strains covered in original meningitis vaccine

A

ACYW

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28
Q

COntraindicationand age restrictions to flu shot

A

Under 6 months and egg allergies
Can do flumist at 2

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29
Q

Flu shot with egg allergy

A

If severe reaction give in a setting equiped to handle anaphylaxis

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30
Q

Risk of MMR vaccine in children under 4

A

Febrile seizures: Exercise caution

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31
Q

MMR and pregnancy

A

Don’t give in pregnancy

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32
Q

Primary v Secondary prophylaxis

A

Primary - Before a first occurence
Secondary - After an exposure

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33
Q

Meningococcus prophylaxis

A

ANyone with contact that has had direct exposureRifampin BID for 2 days
Rocephin and Cipro

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34
Q

Tetanus prophylaxis

A

Wash wound, give tetanus toxid and immuneglobulin

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35
Q

Rabies prophylaxis

A

Healthy appearing animal - observe for 2 days screen for rabies if we can - neg screen don’t treat
Captured wild animal - euthanize and test, treat if positive

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36
Q

High risk rabies animals

A

Skunks
Raccoons
Foxes
Woodchucks
Bats

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37
Q

Bat prophylaxis

A

If we find a bat in the vicinity -rabies until proven otherwise

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38
Q

Rabies vaccine administration

A

Ig SQ around the would
3,7,14 in abdomen
21 for immune comp

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39
Q

How much should baby eat

A

Whenever hungry - feed every four hours for first 4 weeks

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40
Q

Hunger cues in babies

A

Sticking out lips/tongue
Cry
Rooting

Sucking does not always mean hunger

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41
Q

Feeding for 2 month baby

A

2-4 ounces every 3-4 hours

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42
Q

Feeding for 4 month baby

A

4-6 oz per feeding

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43
Q

Feeding for 6 month baby

A

4-5 oz per feeding

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44
Q

Symptoms of overfead baby

A

Colic, Stomach pain, gas, spit up

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45
Q

Daily wet diapers of babies

A

2-3 first 4-5 days 5-6 after that
May not pass stool daily if breast fed - pay attention to comfort

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46
Q

Vitamin D recommendation for babies

A

400 IU per day at birth
Only exception is when drinking 32+ oz of formula

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47
Q

Iron supplementation for babies

A

Needed for breastfeeding - 1mg/kg/dqy

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48
Q

Infant weight monitoring expectation

A

Loose up to 7% birth weight and then gain it back
Follow up weight 3-5 days after birth
Gain 15 grams per day

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49
Q

Maturation of oropharangeal coordination

A

3 months - no food until 4 months

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50
Q

Beginning baby diet after formula

A

Single grain cereal at 4 months
Baby food with new fruits/veggies every 4 days at 6 months
Meats start at 9 months

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51
Q

Signs that we can start non-formula food

A

Can hold head up
Can sit up
Open mouth for spoon
Track spoon

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52
Q

Toddler allergen introduction

A

Introduce when other complimentary foods are - introduce early on if no eczema or allergies

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53
Q

Moderate induration of peanut skin prick test

A

3-7 mm - may be allergic

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54
Q

Age for cows milk introduction

A

At first birthday
Limit to 16 oz per day

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55
Q

Eating for 1-2 year olds

A

Calorie requirement drops sharply - careful to give smaller serving size

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56
Q

Trials to get to like a new flavor

A

Takes up to 20 times - keep trying, don’t replace healthy with unhealthy

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57
Q

Child nutrition recommendation

A

Give options out of healthy choices
3 meals a day and 2 healthy snacks
Don’t use food for a reward
Don’t eat and watch TV

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58
Q

Carb fat and sodium recs for children

A

Fat under 30% of cals
55-60% cals from carbs
Limit sodium from processed foods

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59
Q

Child calorie requirement

A

40 calories for every inch of height recommended between 1 and 3 years

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60
Q

Risk factors for childhood obesity

A

Later bedtime
Diabetic parents

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61
Q

Ghrelin

A

Hormone stimulating hunger secreted by stomach

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62
Q

Leptin

A

Hormone secreted byfat suppressing appetite - decreases with decreasing fat

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63
Q

PYY

A

Hormone secrete by SI suppressing appetite after meals

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64
Q

Healthy weight percentile

A

5-84 percentile

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65
Q

5-2-1-0 rule for childhood obesity

A

5+ fruits and veggies daily
2 hours max screen time per day
1 hour of active play
0 Sugary drinks

Choose one to work on

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66
Q

1 oz in hands

A

2 cupped hands

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67
Q

1/2 cup hands

A

1 cupped hand

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68
Q

Skim milk introduction in children

A

None for first two years

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69
Q

Sleep recommendations by age

A

4-12mo -12-16
1-2 - 11-14
3-5 - 10-13
6-12 - 9-12
13-18 - 8-10

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70
Q

Medications for obesity in children

A

Phentermine - controlles
Qsyma - Not approved for children
Topiramate - not approved but has been used

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71
Q

Bariatric surgery in children

A

Must be over 15 with BMI over 40

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72
Q

Diagnostic criteria for childhood metabolic syndrome

A

3 of 5

Waist circ over 90th percentile
Hypertriglyceridemia (over 110)
HDL under 40
HTN over 90th percentile
Fasting glucose over 110

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73
Q

Prader willi syndrome

A

Loss of genes from chromosome 15q - leads to morbid obesity

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74
Q

Presentation of PW syndrome

A

Hypotonia, feeding issues, excess weight gain, hypogonadism, facial change, developmental delay, excess eating

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75
Q

Monitoring for PW syndrome

A

Check every 1-3 months
Refer to dietician or weight loss specialist if not improvement at 3-6 months

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76
Q

M-CHAT

A

Autism screening for autism
Done at 18 and 30 month

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77
Q

Ages and stages questionairre

A

19 age-specific questions from one month to 9.5 years

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78
Q

5 Areas of evaluation for ages and stages

A

Communication
Gross motor
Fine Motor
Problem Solving
Personal/Social

Graded 0,5, or 10

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79
Q

1-2 month developmental milestones (1 each)
Communication
Gross motor
Fine Motor
Problem Solving
Personal/Social

A

Communication - Coo and Goo
Gross motor - Head erect, turn side to back
Fine Motor - Drops toys
Problem Solving - Follows objects
Personal/Social - Smiles and recognizes parents

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80
Q

3-5 month developmental milestones
Communication
Gross motor
Fine Motor
Problem Solving
Personal/Social

A

Communication - Raspberry sound, Laughs
Gross motor - Sits with support, Turns front to back
Fine Motor -Ulnar grasp, objects to mouth
Problem Solving - Can follow an object but no permanence
Personal/Social - Looks towards voice

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81
Q

Puppy prop

A

3-5 months - can lift head up on tummy

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82
Q

6-8 month developmental milestones
Communication
Gross motor
Fine Motor
Problem Solving
Personal/Social

A

Communication - Babbling
Gross motor - Sits alone for short period, commando crawl, back to stomach
Fine Motor - Bye bye wave, Scoop and grasp, feed self, hand to hand pass
Problem Solving - N/A
Personal/Social - Inhibited by “no”

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83
Q

9-11 month milestones
Communication
Gross motor
Fine Motor
Problem Solving
Personal/Social

A

Communication - Babbling with sound repetition, follow 1 step commands
Gross motor - Full crawl, Pull self to standing, can stand alone briefly
Fine Motor - Neat pincer grasp
Problem Solving - Object permanence
Personal/Social - Understand name and some words, immitates pat-a-cake and peek-a-boo

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84
Q

1 year old developmental milestones
Communication
Gross motor
Fine Motor
Problem Solving
Personal/Social

A

Communication - Mama and Dada specific, peak babbling
Gross motor - Starts to walk on own
Fine Motor -Perfects pincer grasp, two cube tower, points to desired objects
Problem Solving
Personal/Social - Gives toys on request

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85
Q

18 month milestones
Communication
Gross motor
Fine Motor
Problem Solving
Personal/Social

A

Communication, 4-20 words
Gross motor - Seats self in chair, walk down stairs, throw ball
Fine Motor - Dumps things from cups/bottles, feeds self
Problem Solving
Personal/Social - recognizes 3 body parts

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86
Q

Protodeclarative pointing

A

They direct you to an even by pointing

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87
Q

Protoimperative pointing

A

Sees something they want, looks at you and back at the object

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88
Q

2 year milestones
Communication
Gross motor
Fine Motor
Problem Solving
Personal/Social

A

Communication - 50 word vocabulary, can say short phrases
Gross motor
Fine Motor - 6-7 cube tower
Problem Solving, turn pages
Personal/Social - Points to named objects, plays with mimicry, kicks ball on request

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89
Q

30 month milestones
Communication
Gross motor
Fine Motor
Problem Solving
Personal/Social

A

Communication - Use prepositions, Uses I not Me
Gross motor - Walk backwards, hop on one foot
Fine Motor - Copies crude circle, hold crayon in fist
Problem Solving
Personal/Social - Point to object described by use, carry a conversation

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90
Q

3 years milestones

A

Rule of 3s
3 numbers, 3 colors, 3 shapes, 3 wheel bike

9-10 cube tower

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91
Q

3-4 year milestones

A

Climbs stairs with alternating feet
Button and unbutton
What do you do for fun answer
Knows sex
Gives full name
Feeds self
Takes off shoes and jacket

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92
Q

4-5 year milestones

A

Runs and stands on one leg
Draw person with no torso
Copy a square
Knows days of week
What do you do if…cold….hungry
Self care at toilet
Dress self

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93
Q

5-6 year milestones

A

Catch a ball
Skip smoothly
Tell age
Know left and right
Describe favorite TV show
Simple chores
Low danger awareness

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94
Q

6-7 developmental milestones

A

Knows morning and afternoon
Reads one syllable printed words

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95
Q

7-8 developmental milestones

A

Ties shoes
Knows day of the week
Add and subtract 1 digit numbers

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96
Q

Developmental red flags in first year - 4

A

No smile/joy by 6 months
No sitting at 9
Moro past 6 months
No babbling by 12

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97
Q

Developmental red flags after first year

A

No single words by 16 months
Not walking by 18 months
Hand dominance before 18 months
Failure to have 2 or 3 word sentances at 2 and 3 years respectively

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98
Q

Developmental red flag at ANY stage

A

Any regression on skills

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99
Q

Understandability at 2,3, and 4

A

50%, 75%, 100% respectively

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100
Q

Type one growth abnormalities

A

Weight alone is dropping, head an height continue

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101
Q

Type two growth abnormality

A

Drop in height and weight - heart or lung disorder

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102
Q

Type three growth abnormality

A

All three parameters are low - brain or chromosome issue

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103
Q

SGA

A

Below 10th percentile weight baby

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104
Q

Symmetrical IUGR

A

All parameters small due to issue early in pregnancy - worse prognosis

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105
Q

Assymetric IUGR/SGA

A

Only weight is under 10% - late in pregnancy, HTN, better prognosis

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106
Q

LGA

A

90 percentile or more - diabetic or large mother

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107
Q

Failure to thrive

A

Children who fall below the 3rd percentile on the growth curve
OR
Weight has declined across 2 major percentiles

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108
Q

Management for FTT - Mild-Moderate

A

Focus on nutrition and rehabilitation - avoid refeeding syndrome

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109
Q

FTT regimen phase 1

A

100% of daily age requirements given based on day 1 weight, if well tolerated start phase 2

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110
Q

FTT treatment regimen phase 2

A

Increase intake to provide catch-up nutrition

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111
Q

FTT treatment regimen phase 3

A

Offer varied diet as child approaches ideal body weight

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112
Q

Disturbance of growth tx

A

Evaluate by pediatric endocrinologist

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113
Q

Estimate for final height based on parents

A

Average of mom and dad +/- 6.5cm if boy or girl respectively

114
Q

Pathological short stature is most common when -

A

There is an issue with growth velocity

115
Q

Familial short stature

A

Grows along growth curve staying at or below 3rd percentile

116
Q

Constitutional growth delay

A

Delayed onset of puberty with a growth spurt later , follow growth curve and then shoot up
Bone age under calendar age

117
Q

Growth hormone deficiency

A

Order IGF-1 and IGFBP for levels of GH estimate
Decreased growth velocity
Micropenis in males

118
Q

Psychosocial short stature

A

Due to emotional deprivation
Less eating, speech retardation

119
Q

Treatment for pediatric hypothyroidism

A

Start as soon as possible - first month of life is ideal
Levothyroxine is drug of choice

120
Q

Tx for hyperthyroidism in pediatrics

A

Methimazole first choice
Beta blockers for tachycardia
Can also use PTU

121
Q

Neonatal graves disease

A

Flushing, jaundice
Treat w/ steroids and BB temporarily

122
Q

Premature puberty in girls

A

Breast dev before 8 in girls (7 for AA)

123
Q

Central precocious puberty

A

Activation of GnRH leading to an increase in sex steroids
Events identical to normal puberty

124
Q

Peripheral puberty

A

Ovarian or adrenal tumors, Mcune Albright syndrome
Elevated estrogen levels and more rapid changes

125
Q

Tx for precocious puberty

A

Give leuprolide to downregulate GnRH

126
Q

Precocious puberty in boys

A

Changes before age 9
More likely to have CNS abnormalities

127
Q

Delayed puberty in girls

A

No signs by 13, no period by 16
No tanner stage 5 within 4 years of onset = delay
Low dose estrogen and then OCP

128
Q

Delayed puberty in boys

A

No secondary sex characteristics by 14 or no final maturation within 5 years of change beginning
Low dose testosterone to treat

129
Q

Main cause of delayed puberty in both girls and boys

A

Constitutional growth delay

130
Q

Galactosemia

A

Vomiting, Jaundice, Liver inflammation
Need lactose free milk
Newborn screen

131
Q

PKU

A

Mental impairment, hyperactivity, seizures, eczema
Limit dietary phenylalanine

132
Q

Preschoolers and drowning

A

Don’t have any idea of how deep things are - think pool is a bath

133
Q

MCC of death in 5-19 year olds

A

MVA

134
Q

Rear facing car seat

A

Until two years old and up to 35 lbs. - across chest, etc.

135
Q

Forward facing car seat

A

5 point harness until at least 4 or 40lbs.

136
Q

Seat belt for school age children

A

Belt positioning booster seat to get seat belt across hips NOT belly

137
Q

Car seat involved in MVA

A

Must be discarded

138
Q

Reduction of injury with a bike helmet

A

60-90% reduction

139
Q

3 reasons to discard helmet

A

Hits hard surface
Fall results in marks on shell
Over 5 year old helmet

140
Q

Leading cause of death between 1 and 4

A

Drowning

141
Q

Cold water drowning

A

Get them to temperature before declaring prognosis
Warm water is worse

142
Q

Drowning tx

A

Warm up
100% O2
Intubation if satting under 80
IVF
NG tube

143
Q

Time last seen with drowning

A

Within 5 minuts by both parents

144
Q

Tx for 1st degree burn

A

Cool compress and analgesics

145
Q

second degree burn tx

A

Silvadene and analgesics with sterile non adhesive dressing

146
Q

Third degree burn tx

A

Referral, IVF, Airway

147
Q

Tx for electrocution

A

Watch for entrance and exit wounds
EKG, CK, UA, BMP

148
Q

TX for animal bite

A

High pressure and high volume irrigation
Tetanus and Rabies prophylaxis
Suture bites only if you have to - open sutures
Pasturella -tx with augmentin

149
Q

Tx for pediatric choking

A

Under 1 - Hard back blows
Over 1 - Heimlich

150
Q

Quarter in esophagus

A

Face on AP view

151
Q

Age below which no skateboard

A

Under 5

152
Q

Swallowed magnets

A

Can attract in abdomen and loop the bowel

153
Q

Education for kids and ATVs

A

Only on non paved surface
No passenger
Helmet
Prohibited under 16 years
NOT TOYS

154
Q

Repeat concussion risk

A

Likely to experience another in the next 10 days after concussion

155
Q

SCAT5 guidelines

A

Used to determine return to play

156
Q

5 steps for return to play after a concussion

A

No activity
Light aerobic exercise
Sport specific exercise
Non-contact training drills
Full contact practice

Must be symptom free for 24 hours to move to next level

157
Q

Therapy for suspected poinoning

A

Used to do gastric lavage, now more common NG tube with activated charcoal

158
Q

Agents for which activated charcoal may not be used

A

Heavy metals
Inorganic ions
Corrosives
Hydrocarbons
Alcohols
Essential oils

159
Q

COntraindications to active charcoal use

A

Depressed
Late presentation
Risk for aspiration - hydrocarbon
Need endoscopy
Toxins not well absorbed
Intestinal obstruction

160
Q

Tylenol toxicity tx

A

N-Acetylcysteine
150mg/kg loading dose over 15-60 minutes
50mg/kg over 4 hours
100mg/kg over 16 hours

161
Q

Iron toxicity

A

Flintstone vitamins, etc.
Leads to hemorrhagic gastroenteritis, Phase of improvement, and then delayed shock and liver damage
Gastric lavage and whole bowel irrigation

162
Q

Chelation therapy for lead poisoning

A

Succimer 10mg/kg every 8 hours for 5 days then every 12 hours for 4 days

163
Q

Blood lead level to require chelation therapy

A

45+ mcg/dL

164
Q

Rescreaning criteria for blood lead evels

A

5-9mcg/dL should be confirmed within 1-3 months and reapeated after 3 months, then 6-9 months after environmental changes are made

165
Q

Disk shaped battery ingestion

A

Get out if stuck in esophagus - can erode it

166
Q

Well child visit schedule

A

Newborn - 24-48 hours
2 weeks
1,2,4,6,9,12,15,18,24,30,36 months
Yearly after 3 years

167
Q

Growth parameters for well child check

A

Height and weight every visit
Head circumference first three years
BMI staring at 2

168
Q

Failure to thrive definition - Dr. Mousatat

A

Falling by two major percentiles in 6 months
Weight or length under 5th percentile

169
Q

Blood pressure well child monitoring

A

Start at 3 years
Unless they have congenital heart disease

170
Q

Pediatric HTN

A

Greater than 95th percentile or greater than 130/80 (just the last over 13
Need 3 abnormal readings

171
Q

Work up for pediatric hypertension

A

BMP, Lipids, Renal US
Do an echo before starting meds

172
Q

Well child vision monitoring

A

Red reflex
FIxate at 6 weeks
Formal acuity testing begins at 3

173
Q

When to refer for pediatric vision concerns

A

3-4 - worse than 20/40
5 - worse than 20/30
6 - worse than 20/20 - should have normal adult vision at this point
Strabismus or Abnormal red reflex

174
Q

Pediatric hearing screening

A

MCC of hearing loss is congenital infection
Screen neonates with follow up for abnormal results and bring back in two weeks
Get in the system before 6 months
Once a year after 5

175
Q

Sucking reflex persistence

A

Becomes voluntary at 4 months

176
Q

Rooting reflex persistence

A

Disappears by 4 months

177
Q

Palmar grasp reflex persistence

A

Disappears by 3-6 months

178
Q

Moro reflex persistence

A

Disappears by 3-6 months

179
Q

Tonic neck reflex persistence (fencing position)

A

Disappears by 4-6 months - should disappear before baby can roll back to front

180
Q

Traction response persistence

A

Disappears after 6 months

181
Q

Placing response persistence -foot on table, not stepping

A

Disappears at 2 months

182
Q

Stepping response persistence

A

Disappears at 1-2 months

183
Q

When to check for strabismus/amblyopia

A

At 6 months, may be normal before 6 months but should not persit

184
Q

Anterior fontanelle closure

A

Closes at 9-18 months

185
Q

Posterior fontanelle closure

A

Closes at 2-3 months

186
Q

False fontanelle bulging

A

Sit the baby up at 45 degrees to avoid

187
Q

Plagiocephaly

A

Can be due to premature closure of the sutures - if ears are not across from each other/assymetry there is premature closure of the sutures

188
Q

Scaphocephaly

A

Premature closure of sagittal suture - narrow and long head

189
Q

Acrocephaly

A

Multiple suture closures -growth of head upwards

190
Q

Trigonocephaly

A

Frontal suture early closure
Triangular forehead with midline ridge

191
Q

Physiologic plagiocephaly

A

Due to baby back sleeping, give the baby tummy time during the day

192
Q

Treatment for premature closure of sutures

A

3D CT scan
Maxillofacial surgeon if no improvement by 9-12 months
Bloddiest surgery
Skull molding helmet

193
Q

Pediatric dental examination

A

Done with eruption of first teeth usually around 5-8 months
Official dentist visits start around 1
Sucking should be discontinued around 4-5

194
Q

Teething and fevers

A

Teething should not cause a fever

195
Q

Teeth cleaning in pediatrics

A

Clean gums after bottle feed
Teeth cleaning twice a day supervised until 8
Floss when spaces between teeth become too small for brush

196
Q

How much toothpaste to use for kids

A

Under 3 - rice sized
3-13 - Pea sized
13+ slightly larger than pea sized

197
Q

Anemia screening in pediatrics

A

Children from 1-2 years
This is when anemia peaks - can be due to excessive milk intake

198
Q

Hemoglobin testing

A

FInger/heal stick and then follow up with venous stick

199
Q

UA screening in peds

A

Not recommended in healthy, asymptomatic pediatric patients

200
Q

TB screening

A

Identify high risk and screen only them

201
Q

High risk TB children

A

COuntry of origin with high rates
Spent time with TB+ people
Latent TB

202
Q

Dx of TB in children

A

May not be able to obtain a sputum culture
Diagnose based on:
Clinical s/s after exposure
+Skin test or blood test
+CXR

203
Q

HEADSS assesment for teans

A

Home - are they safe at home
Education
Activities/Employment
Drugs
Suicidality
Sex

204
Q

24-48 hour after birth check up

A

Discuss breast feeding - every 2-3 hours or 8-12 times/day
Pooping/peeingok
Circumscision check
Patency of nose and ears
Weight
Back to sleep

205
Q

Umbilical stump removal

A

Sponge bath until it falls off

206
Q

2 week check up for peds

A

Lactation, sleep of mom and baby
Check newborn screen and review
Vitamin D supplement if breastfeeding
Jaundice should resolved

207
Q

1 month peds check up

A

Growth and nutrition
Hep B if not given at birth

208
Q

2,4,6 month peds check up

A

Same vaccines each time
4 - no longer need to wake for feeds
6 - solid food introduction 1 type at a time
Sit, stand, speak, swipe, slobber, switch

209
Q

9 month peds checkup

A

Start table food - nothing needing chewing
No vaccines unless catchup
Mama, dada, gross pincer

210
Q

12 month peds checkup

A

Starting to walk
Whole milk introduced
MMR, Hep A Varicella
1st dentist referral
Fine pincer

211
Q

Fever with child vaccines

A

Delayed fevers with live vaccines - MMR, Varicella

212
Q

15,18,24 moth peds checkups

A

15 - 5 words, climbing, body parts
18 & 24 -MCHAT/ASQ

213
Q

4 year checkup

A

Genital exam - tell them only mom dad doctor can do this

214
Q

MCHAT score interpretation

A

Under 3 - no need to follow up if low risk
3-7 - Administer follow up, intervention if score 2+
7+ - Bypass follow up and refer

215
Q

Homes more likely to have lead

A

THose built before 1950

216
Q

Lead screening for children

A

Can end at 36 months
Need a venous sample

217
Q

Lead poisoning tx

A

Counsel on exposure risk if level 10-19 mcg/dL
Workup and screen for anemia at 20-44 mcg/dL
Activated charcoal at 45-69 mcg/dL
Hospitalize and contact poison control at 70+mcg/dL

218
Q

Medications for lead poisoning - chelators

A

EDTA or Dimercaprol (adjunct to EDTA), Succimer

219
Q

FLuoride deficiency and excess

A

Too little - caries
Too much - Dental mottling

220
Q

Fluoride supplementation

A

Not needed if 0.6+ ppm in water supply
0.3-0.4 ppm - 0.25 mg recommended
Under 0.3ppm - 0.25 from 6 months to three years, 0.5 3-6 years, 1mg 6-16 years

221
Q

Fluorosis

A

Excess fluoride intake causing mottling of teeth

222
Q

4 things that must be shared if told by a teen

A

Suicide
Homicide
Abuse
+ HIV status

223
Q

Legal rights of minors

A

Emergency care
Sex ed starting 6th grade
Birth control
HIV testing

224
Q

3 ways to become emancipated minor

A

Get married
Join Military
Judge declares emancipated - 16

225
Q

Mature minors

A

Over 14 who:
Demonstrate decision making capacity
Non major intervention
Intervention not for another
STD treatment

226
Q

4 preventative services for teens

A

Screening
Counseling for risk
Immunizations
General health education

227
Q

Electronics limit for adolescents

A

1-2 hours per day

228
Q

Warning signs of depression

A

Changes in activity
Changes in emotions
Changes in behavior

229
Q

Leading 2 causes of death in teenagers

A

MVA then Suicide

230
Q

2 Most common methods of suicide

A

Firearm and Suffocation

231
Q

School avoidance

A

Missing 1 week or more of school for an illness which would require serious treatment

232
Q

Stage I HTN in adolescents

A

Over 130/80 in over 13 - 3 separate occasions at least 1-2 weeks apart

233
Q

Stage II HTN in adolescents

A

Over 140/90

234
Q

Elevated BP in adolescents

A

120/80 -129/80

235
Q

Elevated BP in 3-13

A

Between 90 and 95th percentile or between 120/80 and 95th percentile

236
Q

Stage I HTN in 3-13

A

Between 95th percentile and 95th percentile + 12 mmHg (lower one)
or between 130/80 and 139/89

237
Q

Stage II HTN in 3-13

A

Over 95th percentile + 12mmHg or over 140/90

238
Q

Tx for adolescent HTN

A

Stage I - d/u in 3 months if asymptomatic and counsel - may play sports

Stage II - Repeat in one week but initiate lifestyle modification
Medication
NO SPORTS

239
Q

Workup fokr adolescent HTN

A

CBC, CMP, UA (for kidneys), Lipids, Renal US, Echo, HbA1C, TSH, Sleep study for OSA

240
Q

Pharm for adolescent HTN

A

Lisinopril to start, consider ARB, THiazide, CCB

241
Q

Thelarche

A

Breast bud onset - may not start on same day

242
Q

Pubarche

A

Armpit hair and genital hair

243
Q

Adrenarche

A

Androgen dependant changes

244
Q

Menarche

A

First period, 2-3 years after thelarche

245
Q

Tanner staging time

A

Takes 4-5 years
Girls start at 10.5, girls at 11.5

246
Q

Tanner stage I
Breast
Pubic Hair
Genitalia

A

Breast - Preadolescent
Pubic Hair - None
Genitalia - Childhood size

247
Q

Tanner Stage II
Breast
Pubic Hair
Genitalia

A

Breast - Breast bud
Pubic Hair - None
Genitalia - Enlargement of scrotum/testes

248
Q

Tanner Stage III
Breast
Pubic Hair
Genitalia

A

Breast - Areolar diameter enlarges
Pubic Hair - Darker, curling, increased amount
Genitalia - Penis lengthens, testes enlarge

249
Q

Tanner stage IV
Breast
Pubic Hair
Genitalia

A

Breast - Secondary mound, separation of contours
Pubic Hair - Coarse, curly, adult type,
Genitalia - penis grows in length and breadth, scrotum darkens

250
Q

Tanner Stage V
Breast
Pubic Hair
Genitalia

A

Breast - Mature female
Pubic Hair - Extends to thighs
Genitalia - Adult shape and size

251
Q

Testicle volume for tanner stages I-V

A

3,4,10,16,25
Almost square numbers

252
Q

Gynecomastia

A

Usually bilateral and tender
Majority go away in 1-2 years
70% end before 17yrs

253
Q

Precocious puberty

A

Secondary sex characteristics under 8 in girls (7 for AA girls) less than 9 in boys

Just as worried about this as delayed

254
Q

Delayed puberty

A

Later than:
12-13 in girls or no menses at 16
14 in boys

255
Q

Proportion of high schoolers who admit to sexual activity

A

1/2

256
Q

Main reason for amenorrhea

A

Being pregnant

257
Q

PPE vs. Well child check

A

A PPE is not comprehensive and does not substitute for a well child check

258
Q

Locker room sports physical method

A

Athletes line up single file and physician examines them
Few personel but noisy and not private

259
Q

Station method for sports physical

A

Get checked out for diffierent things at different stations - for large volumes

260
Q

Office based sport physical

A

Individual provider may lack training
May not know all that their PCP knows

261
Q

Return to learn post concussion

A

Once can concentrate and tolerate visual and auditory stimulation for 30-45 minutes
May need academic adjustments

262
Q

Return to play post concussion

A

Need to be able to return to play symptom free and off meds -baseline balance and cognitive function
2 weeks min

263
Q

Indications for retirement from contact sports

A

Structural brain abnormailty on imaging
Nonresolving/Prolonged neurocognitive defecits

264
Q

Murmur of hypertophic CM

A

Louder standing and valsalva
Quieter squatting

265
Q

Murmur of aortic stenosis

A

Louder squatting, quieter with valsalva/standing

266
Q

Physical stigmata of marfans syndrome - 5

A

Long arms, legs and fingers
Curved spine
Pectus excavatum
Crowded teeth
Stretch marks not related to weight gain/loss

267
Q

Vision defect that need to be picked up on sports physical

A

Vision worse than 20/40 in at least 1 eye

268
Q

Routine cardiac imaging for sport physicals

A

Controversial EKG and Echo - discouraged if asymptomatic
Use if HCM suspected

269
Q

Malignant coronary artery abnormality

A

LCA goes between aorta and pulm artery and is constricted when eversizing

2nd MCC of on-field death

270
Q

HTN and sports participation

A

Stage I w/o end organ damage may
Stage II may not

271
Q

Exercise induced Asthma and Sports

A

Coughing, wheezing, chest tightness, begin during and worse 5-10 minutes after stopping

272
Q

Tx for exercise induced asthma

A

Albuterol 20 minutes before exercise

273
Q

Diabetes and sports

A

Can play sports

274
Q

Enlarged spleen and sports

A

In mono - should avoid

275
Q

Obesity and sports

A

Only a contraindicationif comorbid conditions such as HTN

276
Q

Osgood-Schlatter syndrome

A

Common in boys 12-15 and girls 11-13
Pain aggravated by quad movement, can inhibit activity
Resolves as athlete reaches maturity

277
Q

O-S Syndrome tx

A

NSAIDs, PT, and Ice

278
Q

Female athlete triad

A

Dance, cheer, gymnastics, running
Low caloric intake w/ or w/o disordered eating
Menstrual dysfunction
Low bone density

279
Q

Tx for female athlete triad issues

A

Reduce training by 25% and increase intake by 200-600 calories
F/u in 1-2 weeks

280
Q

3 recommendations for sports physical

A

Cleared to play
Cleared with additional f/u
Not cleared

281
Q
A

Pediatrics (3 decks)

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